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Updated: Oct 1, 2025
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Incidence of Medical Adhesive-Related Skin Injuries and Associated Factors After Pediatric Congenital Heart Surgery:
Jeiel Carlos Lamônica Crespo1,2,3,4,5,6,7,8, Daniela Reuter do Amaral1,2,3,4,5,6,7,8, Ticiane Carolina Gonçalves Faustino Campanili1,2,3,4,5,6,7,8
1Jeiel Carlos Lamônica Crespo, Master of Science, Heart Institute, University of Sao Paulo, Sao Paulo, SP, Brazil.
Insights
Medical adhesive-related skin injuries (MARSI) affect over 60% of pediatric patients post-heart surgery. Transparent film dressings are a common cause, highlighting the need for preventative strategies.
Area of Science:
- Pediatric Surgery
- Intensive Care Medicine
- Dermatology
Background:
- Medical adhesive-related skin injuries (MARSI) are a significant concern in healthcare settings.
- Identifying risk factors and incidence is crucial for effective prevention strategies, especially in vulnerable patient populations.
Purpose of the Study:
- To determine the incidence and characteristics of MARSI in children undergoing congenital heart surgery.
- To identify factors associated with the development of MARSI in this pediatric cohort.
Main Methods:
- A prospective cohort study was conducted in a pediatric surgical intensive care unit (ICU).
- 136 children were monitored daily for skin assessments post-operatively until MARSI onset or ICU discharge.
- Statistical analyses included Fisher's exact test, Pearson's χ2 test, Mann-Whitney test, Brunner-Munzel test, and Welch 2-sample t test.
Main Results:
- The incidence of MARSI was high at 60.3%, with the majority occurring by postoperative day 2.
- Transparent film dressings were the most frequent cause of MARSI (86.6%).
- Factors associated with MARSI included younger age, increased number of devices, lower Braden Q score, longer surgery/bypass/ventilation times, and longer ICU stay.
Conclusions:
- The high incidence of MARSI necessitates increased clinical awareness and proactive interventions.
- Avoiding polyurethane transparent film dressings without concurrent skin barrier products is recommended to mitigate MARSI risk.
Purpose:
The aim of this study was to identify the incidence, characteristics, and factors associated with medical adhesive-related skin injuries (MARSI).
Design:
Prospective cohort study.
Subjects And Settings:
The sample comprised 136 children in the postoperative period after congenital heart surgery. The study setting was in a 31-bed pediatric surgical intensive care unit (ICU) of a university hospital in Sao Paulo, Brazil.
Methods:
Patients were followed from admission, with daily skin assessments, until the onset of MARSI or ICU discharge. Outcomes were compared by Fisher's exact test, Pearson's χ2 test, Mann-Whitney test, Brunner-Munzel test, and Welch 2-sample t test.
Results:
The incidence of MARSI was 60.3%, with 85 injuries in 82 patients. The highest occurrence was on postoperative day 2 (27 wounds; 31.8%). The most frequent medical adhesive associated with MARSI was transparent film dressing (n = 74; 86.6%). Factors associated with MARSI were age (P = .000), number of devices inserted (P = .000), Braden Q Scale score (P = .005), duration of surgery (P = .021), cardiopulmonary bypass duration (P = .000), duration of mechanical ventilation (P = .000), and length of ICU stay (P = .000). Children who developed MARSI received more blood components (P = .039), vasopressors (P = .000), and corticosteroids (P = 0.000); required longer sedation (P = .000); and had more edema (P = .001).
Conclusion:
This high incidence indicates the need for greater awareness and prompt action in response to MARSI. Polyurethane transparent film without concurrent use of a skin barrier product should be avoided.
